Clinical Analytics Boosts EHR Effectiveness

PricewaterhouseCoopers study reveals that more providers, payers, and pharma companies are investing in business intelligence tools needed to make data more actionable.

5 Key Elements For Clinical Decision Support Systems

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If healthcare organizations want to achieve the oft-mentioned goals of improving population health and reducing overall costs, they would do well by investing not just in electronic health records (EHRs), but also in clinical analytics, according to a survey from the Health Research Institute of consulting firm PricewaterhouseCoopers.

"To improve patient outcomes, proactively identify chronic and high-risk patients in this new environment, and effectively manage their financial performance, healthcare organizations must be able to provide analytics at the point of service and rely on historical and longitudinal data to manage patient populations," said the report. But providers seem to have a long way to go.

Among payers, 85% indicated that they expected clinical informatics to help them better manage complex illnesses such as cancer, while 80% said they are looking to prevent unnecessary visits to emergency departments and hospital readmissions.

PwC surveyed more than 600 IT and clinical leaders from hospitals, physician practices, health insurance companies, pharmaceutical manufacturers, and life sciences companies nationwide. The firm conducted about 30 in-depth interviews with CIOs and other leaders at some of the organizations.

Despite the optimism about the potential of clinical analytics, just 15% of insurance companies and 13% of providers said they have successfully applied informatics to influence patient behavior. Less than one-third of providers and fewer than half of payers and pharmaceutical or life sciences companies surveyed said that they currently exchange electronic information with external parties.

According to John Edwards, a director at PwC, providers still are concerned that data they give to payers might hurt them when it comes to negotiating reimbursement rates. "There's some hesitance about sharing this information," Edwards told InformationWeek Healthcare.

Payers are trying to change this perception by offering information to providers that is "more actionable" and convenient, Edwards said.
For example, Aetna, which already owned clinical decision support and analytics services company ActiveHealth Management, bought health information exchange provider Medicity in early 2011. According to Edwards, Medicity had the "pipes" for moving data around, but not the analysis needed to help healthcare professionals and case managers make better decisions.

This is a trend that should continue, Edwards said, since there is increasing pressure from employers and other major purchasers of health insurance to make employer information more relevant and accessible to clinicians.

On the provider side, organizations are starting to see that EHRs by themselves have limited potential. "In the clinical space, there was a belief that if you put in an EHR, all your problems of interoperability would go away," Edwards said. "There is evidence in the survey that providers were realizing that the 'silver bullet' of EHRs needed to be enhanced with clinical informatics people," he added.

Close to half of providers expect to add technical analysts in the next two years, while 35% will hire additional clinical informaticists, according to the survey. Some 70% of insurance companies will boost staffing on the technical side of clinical analytics and 30% will add informaticists.

PwC also found that organizations with formal informatics programs in place were farther along in the quest to produce better, more efficient care at lower cost. However, many of these leaders reported that they felt like they were far from achieving their goals in clinical informatics because organizations that had invested in business intelligence were finding new sets of questions that they had not considered before. "Basic questions lead to more advanced questions," Edwards said.

More advanced organizations have realized "that the mountain they had to climb was bigger and steeper," he added.

Edwards noted that PwC interviewed people at Intermountain Healthcare, a large, integrated delivery system in Salt Lake City that first started exploring clinical informatics in the 1960s. "Their people are just dreaming up new things to dig up," Edwards said. The same thing is true at large insurance companies such as WellPoint and UnitedHealth Group, he said.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)